Trump Administration Requests Supreme Court Review of Medicaid Work Requirements

For the past two and a half years, the Trump administration has been pushing states to adopt policies requiring certain Medicaid recipients to work in order to maintain eligibility for benefits. At every step along the way, courts have ruled that such requirements are illegal. Now, the administration is looking to the U.S. Supreme Court for support.

The Department of Justice filed a petition for writ of certiorari to the Supreme Court on July 14, 2020, asking the Court to overturn a recent decision striking down Arkansas’ Medicaid work requirements. Specifically, the U.S. Court of Appeals for the District of Columbia ruled in February 2020 that the Trump Administration could not permit Arkansas to impose work requirements on Medicaid beneficiaries because such requirements do not further the Medicaid Act’s primary objective, which is to expand health care coverage to low-income populations.

Under the Medicaid program, the Department of Health and Human Services (HHS) generally sets the underlying coverage requirements and then states furnish the actual services. States, however, have the option to petition the Secretary of the HHS for waivers to depart from traditional Medicaid requirements, for experimental purposes, if the departure would further the Medicaid Act’s underlying purposes.

In January 2018, HHS released guidance to state Medicaid agencies encouraging them to petition for waivers to impose work requirements on Medicaid beneficiaries. HHS has approved work plans for several other states besides Arkansas.  Under the waiver that HHS approved for Arkansas, Medicaid beneficiaries in the state were required to report 20 hours of work or work-related activity weekly. Medicaid coverage was automatically terminated for beneficiaries who failed to report 80 hours monthly for three straight months.

On paper, people with disabilities were exempt from these requirements, along with children, pregnant women, and the elderly. However, a November 2018 report from the Center on Budget and Policy Priorities found that thousands of people with disabilities fell through the cracks in Arkansas’ program, and thus lost Medicaid coverage as a result of the work requirements.

At the D.C. Circuit, and now to the Supreme Court, the Trump administration has argued that work requirements further a variety of purposes implicit in the Medicaid program, including “improving health outcomes, addressing behavioral and social factors that influence health outcomes, and incentivizing beneficiaries to engage in their own health care and achieve better health outcomes.”

“Arkansas Works’ model was designed to encourage able-bodied Arkansans without dependents to transition into the workforce, building a stronger, more resilient connection with their communities,” Arkansas Attorney General Leslie Rutledge said in a statement.

The D.C. Circuit ruled that regardless of any alleged health or social benefits of work requirements, HHS had not demonstrated how the work requirements would further Medicaid’s primary objective of expanding health coverage to low-income people.

“While furnishing health care coverage and better health outcomes may be connected goals,” the D.C. Circuit wrote in its opinion, “the text [of the Medicaid Act] specifically addresses only coverage. . . the Secretary disregarded this statutory purpose in his analysis. While we have held that it is not arbitrary or capricious to prioritize one statutorily identified objective over another, it is an entirely different matter to prioritize non-statutory objectives to the exclusion of the statutory purpose.”

A study published in September 2020 found that Arkansas' work requirement for Medicaid recipients failed to increase employment.